Ask the Doctors

Dear Doctor: Many doctors in my area recommend CoQ10 in conjunction with statin drugs to reduce or eliminate muscle pain. It has worked for my wife, and we have heard lots of anecdotal evidence from friends who use it. What's the evidence behind the use of CoQ10 with statins?

Dear Reader: First, let's take a look at statins. These drugs have been repeatedly shown to lower cholesterol levels -- leading to decreased rates of atherosclerosis, heart attacks and strokes -- but they can have side effects. The most common side effect I've seen among my patients is muscle pain, which is the reason that most people stop these very beneficial drugs.

Now let's look at CoQ10. This coenzyme is needed for energy production within muscle cells. Some studies have shown that statins decrease the concentration of CoQ10 in both muscle tissue and in the bloodstream. The hypothesis is that, if you decrease the CoQ10 levels, you reduce the production of energy in muscle cells and they won't function as well, leading to muscle aches, weakness or inflammation.

In extremely severe cases -- I've seen this in very few of my patients -- statins can lead to the death of muscle cells, and a decrease in muscular CoQ10 may be one of the reasons. Massive cell death can also lead to acute kidney failure, but fortunately, in most cases, after stopping the statin and getting intravenous fluids, the patient's symptoms will quickly improve.

As for whether taking CoQ10 can prevent the side effects of statins, the studies of CoQ10 supplementation with statins are small and not conclusive. A 2007 study in the American Journal of Cardiology showed a 40 percent decrease in pain among statin users who took 100 milligrams of CoQ10 daily versus those who took 400 international units (IU) of vitamin E daily. However, there were only 18 people in the group that took CoQ10, so it's difficult to make an overarching conclusion about CoQ10's benefits. Other small studies have not shown any benefit from supplementation.

A combined analysis of six studies published in 2015 in Mayo Clinical Proceedings found a slight decrease in pain among statin users who took CoQ10, but the decrease was not clinically significant. The authors concluded that a larger study was needed.

Based on these studies, and the lack of a large study to evaluate CoQ10, it would be difficult to recommend CoQ10 to prevent muscle pain. However, judging by some of my patients' experiences and by your wife, some statin users have found significant pain relief with CoQ10.

My general thought on the matter is, if you have muscle symptoms with a statin, you should probably change the type of statin you're getting. Some types, such as rosuvastatin and pravastatin, don't concentrate in the muscles as much as others, causing fewer muscle problems. Switching to them may have benefit. Taking 100 milligrams of CoQ10 may also have benefit, but again, a large trial will be necessary to further evaluate this.